Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p &lt; 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.</jats:p></jats:sec>

Natural History of Acromegaly: Incidences, Re-operations, Cancers, and Mortality Rates in a National Cohort

“…The present investigation of a population-based nationwide cohort study focusing on acromegaly provided broad coverage and virtually complete follow-up for a large-scale population that substantially reduced the selection bias like other studies of such kind [14][15][16][17]. Specifically, the present analysis quantified, for the first time, the risks of cancer and mortality with age and sex specifications.…”

Association of Depression and Cervical Spondylosis: A Nationwide Retrospective Propensity Score-Matched Cohort Study

“…The adherence and efficacy of this reimbursement procedure and NHI program had been discussed and addressed formally [ 22 ]. The diagnosis of depression and cervical spondylosis in NHIRD would be convincible since many associated studies have been published [ 25 , 26 , 27 , 28 , 29 ].…”

Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives

“…Furthermore, in an even larger cohort from the same region, patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. 12 Because male sex, the coexistence of OPLL, and nonoperative management are twice as likely to be associated with subsequent SCI, surgery is therefore suggested for these patients with CSM, especially for those who are at higher risk. 12,68,70,71 The main components contributing to the cervical cord compression and subsequent CSM could be classified into static and dynamic factors.…”